Perceptions of busyness in the emergency department: an opportunity to address a training gap through competency based education

In this issue, Chan et al. report interesting perspectives on the notion of ‘busyness’ in emergency departments (EDs) [1]. Specifically, they found that faculty and junior residents differed significantly in their conception of busyness and that faculty development around teaching managerial skills is deficient. We feel that the authors have outlined both an issue that cuts to the heart of what it means to be an emergency physician and an opportunity offered up by the imminent migration to more competency-based educational (CBE) approaches. Management of complicated patient presentations and flow issues are core competencies of emergency physicians [2, 3]. The Canadian Association of Emergency Physicians defines emergency medicine as (emphasis ours): ‘a field ... comprised of a unique set of competencies required for the timely evaluation, diagnosis, treatment and disposition of all patients with injury, illness and/or behavioural disorders requiring expeditious care, 24/7/365’ [4]. Modern emergency medicine curricula include such core competencies as ‘Demonstrate knowledge of and utilize specific strategies to manage emergency department crowding’ and ‘Facilitate management of unexpected surges in patient numbers and/or acuity’ (Canada) or ‘Employs task switching in an efficient and timely manner in order to manage the ED’ and ‘Participates in strategies to improve healthcare delivery and flow’ (US) [5, 6]. We posit that the major system ‘valueadd’ of emergency physicians is precisely their acquisition